Starts w/ Cepha- or Cefa-

Structure:  B-lactam + dihydrothiazine ring + side chain

Mechanism:  Inhibits transpeptidase (same as PCN)

Advantage over PCNs: resist many B-lactamases

1st gen Cephalosporin

Resist Staph PCNase

G+, and G- (PEcK - Proteus, E. coli, Kleibsiella)
PEcK INC urinary pH --> urinary stones

IV

1st gen Cephalosporin

Resist Staph PCNase

G+, and G- (PEcK - Proteus, E. coli, Kleibsiella)
PEcK INC urinary pH --> urinary stones

Oral

1st gen Cephalosporin

Resist Staph PCNase

G+, and G- (PEcK - Proteus, E. coli, Kleibsiella)
PEcK INC urinary pH --> urinary stones

Oral

2nd gen Cephalosporins

Less G+, INC G -

Covers PEcK + H. influenza & some Neisseria (HNPEcK)

Oral every 8 hrs, assoc w/ serum sickness Sx

2nd gen Cephalosporins

Less G+, INC G -

Covers PEcK + H. influenza & some Neisseria (HNPEcK)

q 12 hr

Oral, IV, IM

2nd gen Cephalosporins

Less G+, INC G -

Covers PEcK + H. influenza & some Neisseria (HNPEcK)

Cephamycin

Use:  Bacteroides fragilis

2nd gen Cephalosporins

Less G+, INC G -

Covers PEcK + H. influenza & some Neisseria (HNPEcK)

MTT (methylthiotetrazole) side-chain antagonizes Vit K --> hypoprothrombinemia; must supp w/Vit K

**Dosage depends on pt compliance

3rd gen Cephalosporin

Less G +, INC G -

IV/IM

Highly protein bound, displaces bilirubin, Caution: do not use <3 mo old, unless single dose for gonorrhoeae conjunctivitis

1/2 excreted in urine, 1/2 in bile

Uses:  Meningtitis (fr S. penumonieae & N. meningitidis)

FDA:  Do not use w/ Ca products in pts <28 days old; older pts - give Rx sequentially, flush line, wait 48 hrs in bet Rx and Ca product

SIDE EFFECTS:  'sludge' in kids (nausea, anorexia, etc), reversible, hepatitis (rare)

3rd gen Cephalosporin

Less G +, INC G -, Bacteroides

IV/IM

Parent & metabolic active

3rd gen Cephalosporin

Less G +, INC G -

Oral

3rd gen Cephalosporin

Less G +, INC G - 

Oral 

Excreted unchanged

Binds Fe --> DEC absorption; reddens feces in infants on formula (high in Fe)

3rd gen Cephalosporin

Less G +, INC G -

IV/IM

Side Effects:  neuorologic (myoclonus, EEG changes, disorientation), Caution if epiletic

4th gen Cephalosporin

Use:  G- rods resistant to 3rd gen

IV/IM

Side Effects:  neurologic (disorientation, myoclonus, EEG changes), Caution if epiletic

Renal excretion - adjust for renal function

4th gen Cephalosporin

G- rods resistant to 3rd gen

Pro-drug (must be activated)

Hydrolyzed by esterases

Advanced gen

IV proRx q 12 hr for CABP (community-acquired bacterial pneumonia), skin infections (MRSA)

Side Effects:  nausea, diarrhea, rash

• Hypersensitivity - risk of cross-allergy w/PCN > w/1st gen unless documented Type I IgE to PCN
• Nephrotoxicity - but lower than aminoglycosides
• FDA: risk of immune-mediated hemolytic anemia

Ends in -penim

Broadest B-lactams

G + / -, anaerobes, resistant infections

Rx. Interaction (class effect) - DEC valproic acid --> INC seizures

• Impenim w/Cilastatin - IV/IM - UTIs

Side Effects:  N&V, seizures (1.5%)